Preventing Vibration White Finger

If you use vibrating power tools, such as jackhammers, sanders, chainsaws, and lawnmowers, you may be susceptible to a condition known as vibration white finger (VWF). Those who suffer from VWF experience a loss or change of color in their fingers, tingling, and throbbing.

white finger preventionWhen someone is experiencing an occurrence of VWF, the tiny blood vessels in the fingers constrict (called a vasospasm), causing a reduction of blood supply to the fingers. This lack of blood initially turns the fingers white. After the oxygen in the remaining blood is used up, the fingers turn blue (a condition known as cyanosis). Once the spasms subside, the fingers turn red as oxygen-rich blood rushes back to the fingers.

To help prevent VWF, the following should be considered:

•    Stay warm and dry when operating machinery
•    Take regular breaks
•    If possible, use a tool that has some form of vibration-damping technology
•    Ensure tools are properly maintained (poorly maintained tools may vibrate more or at a different frequency)
•    Ensure that the right tool is used for a particular job (the wrong tool may take longer, exposing you to more vibration)

Kevin R. Knox, M.D. Provides Medical Expertise in Kenya

Kevin R. Knox, M.D.

Kevin R. Knox, M.D.

Kevin R. Knox, M.D. was in Kenya this week as part of the partnership between Indiana University in the United States and Moi University in Kenya. Dr. Knox will be providing educational expertise as well as medical care.

The partnership between Indiana University in the United States and Moi University in Kenya represents a unique model. Since 1989, Indiana University School of Medicine and Moi University School of Medicine (MUSM) in Eldoret, Kenya have collaborated to promote collegial relationships between American and Kenyan medical doctors, scientists, and students, and to develop leaders in hea

lth care in Kenya and the United States. The mission of this new partnership was to develop leaders in health for the United States and Africa, foster the values of the medical profession, and promote health and well-being in both countries.

This medical school-medical school partnership is built on the premise that individual and institutional good derives from the integrity of individual counterpart relationships. The IUSM-MUSM partnership emphasizes bilateral exchange, mutual benefit, and long-term commitment. The partnership is departmentally based and integrated across multiple disciplines and throughout all levels of both institutions from student body to Department Heads and Deans. Funding comes from multiple sources including philanthropic support.

Brandon S. Smetana, M.D. takes part in the ASSH Young Leaders Program

Brandon S. Smetana, M.D. was recently selected as one of only 15 distinguished hand surgeons in the country to take part in the ASSH Young Leaders Program in Chicago. The prestigious program, sponsored by the American Society for Surgery of the Hand, gives enthusiastic and dedicated young surgeons the opportunity to develop leadership skills and increase their involvement in the society at the national level.  Members selected for this program participate in an active, ongoing discussion to identify key issues within the upper extremity profession and present their research and findings to the Council.

Issues discussed in this year’s Young Leader Program included topics ranging from developing methods to standardize educational curricula and skills for future hand surgeon trainees to pursuing initiatives to improve the efficiency and care for patients in the Emergency Department.

Dr. Smetana has become increasingly involved in numerous committees focusing on education since the conclusion of the program including initiatives to better define essential elements of hand fellowship training and to assist with the education of the next generation of hand surgeons through involvement in the AE Flatt Residents and Fellows Conference Committee and the Young Members Steering Committee. His involvement and ongoing commitment to advancing the field will continue the long standing tradition of the Indiana Hand to Shoulder Center as we seek to provide the most up to date and cutting edge care to patients in our community.

Preventing Frostbite

Exposure to cold temperatures for a prolonged time can result in frostbite, which causes the skin and surrounding tissues to freeze. Frostbite commonly occurs in the fingers, which may lead to loss of feeling and skin discoloration. In severe cases, frostbite can also cause permanent damage and/or loss of fingers. If you’re going to be outside in the cold weather, be sure to protect your hands.

Frostbite can occur even when the temperature is above 32 degrees fahrenheit. Wind chill and moisture contribute to frostbite conditions. Dress in layers, including warm insulated gloves and always carry a pair in your car in case you become stranded or encounter car trouble.

Recognize frostbite symptoms

• Numbness/tingling feeling
• Skin discoloration
• Hard or waxy skin
• Blisters or blackened skin

If you suspect frostbite, follow these guidelines and seek immediate medical attention:

• Go immediately to a warm place.
• Carefully remove wet gloves.
• Refrain from rubbing or scratching the affected area.
• Carefully submerse affected affected fingers in warm (not hot) water for 30 minutes until medical care is available.
• Cover the area with a warm towel or blanket to thaw.
• If available wrap each frostbitten finger loosely with sterile gauze.
• Thaw a frostbitten area only if it can be kept warm. Refreezing a frostbitten finger can result in permanent loss.
• Do not touch blisters occurring from frostbite.

Coping With a Cast

After a bone is broken, either accidentally or for a surgical procedure, a cast is often used to let the bone heal properly. While uncomfortable and cumbersome, casts are extremely important in the treatment of fractures and preventing further problems. And caring for that cast is an essential part of that healing process. So how do you deal with a cast – especially when it starts to itch?

Keep the cast dry: Keep the cast and the cotton wrap around the injury dry at all times. If you want to wash, carefully wrap the cast in plastic and protect the cast from any water.

Don’t stick anything under the cast: Try to keep objects out from under the cast, and especially avoid the urge to stick coat hangers under the cast-this can damage both your skin and the cast material.

Trim rough edges: Rough edges of the cast can be trimmed with an emery board. Do not cut the cast with scissors or attempt to break off rough edges.

Relieve itching the right way: To relieve itching under the cast, try pointing a hairdryer on a cool-air setting down the cast to relieve the itch. Over-the-counter medications such as Benadryl can sometimes help.

Inspect the cast carefully: Examine the cast regularly and alert your doctor if it cracks, breaks, or becomes loose. Also look for reddened or raw skin around the cast edges-your doctor can pad these areas to prevent problems.

Tips for comfort:
• Elevate the injured extremity to prevent swelling in the initial days following the injury.
• Exercise the extremity. Even if your arm is in a cast, don’t neglect the fingers. Alert your doctor if the exercise causes pain.
• Apply an ice bag to the cast to help reduce swelling. If you attempt to ice the broken bone, be certain you keep the cast dry.

Indiana Hand to Shoulder Center Physicians named in Indianapolis Monthly Top Docs



The annual Top Docs issue of Indianapolis Monthly (November) is out and 6 of our physicians are featured in the Hand Surgery section. Congratulations Dr. Baltera, Dr. Creighton, Dr. Fischer, Dr. Greenberg, Dr. Kaplan and Dr. Merrell.


William B. Kleinman, MD awarded the Lee Osterman Teaching Award

It is with deep gratitude and respect that the Physicians of the Indiana Hand to Shoulder Center congratulate their colleague William B. Kleinman on the reception of the Lee Osterman Teaching Award.  The Osterman award is granted to only one member of the ASSH (American Society for Surgery of the Hand).  The recipient is a member who has dedicated his or her career to the advancement of the Surgery of the Hand education.  The recipient is deemed to have demonstrated excellence in educating students, resident and fellows, as well as other Hand Surgeons.  During the course of his career Dr. Kleinman has trained thousands in his specialty.  He has been in the practice of hand and upper extremity surgery at the Indiana Hand to Shoulder Center since the completion of his post-residency Fellowship training in 1978. He earned his doctorate degree in medicine from Cornell University/New York Hospital in New York City in 1972. He completed a two-year general surgery residency at the University of Colorado Medical Center in Denver in 1974, followed by a return to New York City to complete his three-year residency training in orthopaedic surgery at Columbia-Presbyterian Medical Center in 1977. His formal one-year Fellowship training in Hand Surgery was also completed at Columbia-Presbyterian, under the tutelage of his legendary mentor, Dr. Robert E. Carroll. Dr. Kleinman’s training in microvascular reconstruction followed at Duke University Medical Center in North Carolina.

He is a full Clinical Professor of Orthopaedic Surgery at the Indiana University School of Medicine. Much of his work at the I.U. Medical Center throughout his career has been in children with hand and upper extremity birth defects. Services have been provided through the Congenital Hand Deformities Clinic at the Riley Children’s Hospital, where he served as founder and director from 1978 to 1995.

The Indiana Hand to Shoulder Center has provided excellence in care of the hand, wrist, elbow and shoulder for over 45 years.  Their world class team treats simple conditions to complex/traumatic injuries.  With teaching requests worldwide, and patients coming from around the globe, the physicians at the Indiana Hand to Shoulder Center stand ready to offer compassionate care and excellent surgical outcomes.